From the Research
Introduction to Celiac Axis Stenosis
The celiac axis, also known as the coeliac axis, is a critical artery that supplies blood to the upper abdominal organs. A marked change in the angulation of the celiac axis can lead to stenosis, which may or may not have a hemodynamic impact on the splanchnic circulation 1.
Causes and Diagnosis of Celiac Axis Stenosis
Celiac axis stenosis can be caused by extrinsic or intrinsic factors, and its diagnosis is crucial for the management of upper gastrointestinal disease 1. The use of computed tomography (CT) angiography has led to more frequent diagnoses of celiac artery compression by the median arcuate ligament (MAL) 2.
Treatment Options for Celiac Axis Stenosis
The treatment options for celiac axis stenosis depend on the underlying cause and the severity of the stenosis.
- Surgical Treatment: Surgery is the method of choice for celiac axis compression syndrome, and indications for surgical reconstruction are symptomatic patients with arterial stenosis over 50% 3.
- Interventional Radiology: Percutaneous transluminal angioplasty and stenting of the coeliac artery stenosis can be used in the treatment of mesenteric angina 4.
- Management of Celiac Axis Stenosis: Management of celiac axis stenosis is multidisciplinary and may involve interventional radiologists, gastrointestinal surgeons, vascular surgeons, as well as medical physicians 1.
Classification and Proposals for Management
Celiac axis stenosis can be classified based on the severity of the stenosis, and preoperative grading of celiac axis stenosis can make pancreatoduodenectomy safer with maintenance of the upper abdominal organ blood flow in patients with MAL compression 5.
Key Considerations
- Proper diagnosis and early surgical treatment are essential for treating chronic visceral ischemia and reducing surgical complications 3.
- The normal anatomy of the celiac axis, when seen on CT angiography images, demonstrates that it exits the aorta downward and then shifts upward, and a hook or J shape should not be interpreted as resulting from external compression 2.
- Celiac axis compression by the MAL occurs in a subset of the normal asymptomatic population, and its presence should be considered in the management of upper gastrointestinal disease 2.
Treatment Approaches
The treatment approaches for celiac axis stenosis include:
- Resection of the median arcuate ligament and nerve fibers of the celiac axis
- Resection of the stenotic or occluded celiac axis
- Reconstruction of the blood supply to the celiac axis by aorto-celiac bypass, using prosthetic or venous grafting or patch plastic of celiac axis stenosis 3.
- Percutaneous transluminal angioplasty and stenting of the coeliac artery stenosis 4.
Caveats and Differentials
It is essential to consider the potential complications and differentials in the diagnosis and treatment of celiac axis stenosis, including: